Diabeti dhe komplikimet Erëblin Lahu

Pyetje-Kumar&Clark’s Clinical Medicine Erëblin Lahu

Diabeti dhe komplikimet l 2021 tiple

ESTIONS
Question 1
I would like to know the exact mechanism of entry of potassium into
cells under the influence of insulin.

Question 2
I am seeing an increasing number of diabetic patients in primary care
who have elevated fasting blood glucose readings but postprandial
measurements that are normal or only slightly high. Does this indicate
insulin resistance in these patients? What is the reason for this trend?

Question 3
What are the latest diagnostic criteria for the diagnosis of diabetes
mellitus?

Question 4
What test is recommended for diabetes and can the same be used to
diagnose diabetes in a child?

Question 5
What is the value of glycosylated haemoglobin (HbA1C) in diabetes
mellitus?

Question 6
I read in a book that in diabetics the random blood sugar is more
important than the fasting; on a medical website I noted that, for a
patient with type 2 diabetes, the fasting blood sugar level is more
important. What do you say?
Is it acceptable to let the fasting blood sugar remain at approximately
1.5 mmol/L above the upper limit in a patient of _ 60 years with type 2
and presently on oral therapy?
199
Question 7
In type 2 diabetes, which blood sugar – fasting or random – is more
revealing prognostically?

Question 8
Why are the fasting and 2-hour blood glucose levels needed in a diabetic
patient being treated with oral antidiabetic drugs?

Question 9
Is it sufficient to use a fasting blood sugar and glycosylated haemoglobin
(HbA1C) level as a guide to modify the insulin or oral antidiabetic dose
without considering the 1 and 2 hour postprandial values?
Diabeti dhe komplikimet Erëblin Lahu

Question 10
What is the value of the 2-hour postprandial blood sugar level above
which the dose of an oral antidiabetic should be increased if this value is
exceeded several times despite dietary modification?

Question 11
What does BM mean in relation to blood sugar monitoring?

Question 12
What is the role of urine examination in diabetic control?

Question 13
Diabetes and diet: could the authors of my favourite medical text please
advise whether or not it is acceptable to have controlled quantities of
refined sugar, providing the total calorie intake is kept under control?

Question 14
Do non-obese patients with impaired fasting glucose, i.e. a glucose level
of 6.1–6.9 mmol/L, need drug treatment with biguanides if lifestyle
modifications fail to normalize?

Question 15
Do non-obese patients with impaired glucose tolerance (but not fulfilling
the criteria for diabetes mellitus) need drug treatment with biguanides if
lifestyle modifications fail to normalize their post-prandial blood glucose
measurements?

Question 16
It is the Muslim month of fasting currently. I would be grateful if you
could advise on how to adjust the insulin regimen of a type 1 diabetic
patient, for example a 21-year-old girl who is on subcutaneous Actrapid
(short-acting soluble insulin) 22 units t.d.s.

Question 17
I would like to know more about the use of the glitazone group in type 2
diabetes: its action, side-effects, precautions taken on using them.

Question 18
In a patient receiving oral antidiabetics, should the drug be administered
just after taking the blood sample for fasting blood glucose level (and
before a meal), or just prior to the sample being taken?

Question 19
What oral antidiabetics are safe in pregnancy?

Question 20
Is it necessary to put all type 2 diabetics on aspirin?

Question 21
Diabeti dhe komplikimet Erëblin Lahu

In the chapter on diabetes you wrote that you should avoid tablets
before age of 40 years in non-insulin-dependent diabetes mellitus
(NIDDM). Why is this, because in our country most doctors are
prescribing this?

Question 22
1. Should a patient poorly controlled on glibenclamide 15 mg a day and
metformin 1500 mg a day be moved onto insulin?
2. What are the indications for insulin in type 2 diabetics?

Question 23
What happens to the insulin-secreting capacity of a type 2 diabetic
placed on insulin therapy earlier than recommended? Can the external
supply of insulin improve the functional capacity of the insulin-secreting
cells, to some extent by providing some rest to these cells?

Question 24
1. Is inhaled insulin a suitable substitute for injectable insulin?
2. Is there, or will there soon be, insulin in the form of a tablet?

Question 25
What are the complications of insulin other than hypoglycaemia and
injection?

Question 26
I would like to know the processes that go into administering the
Alberti’s/modified Alberti’s regime in patients with uncontrolled
diabetes mellitus.

Question 27
Is there any role for steroids in the management of resistant diabetes
mellitus (daily insulin requirement exceeding 100 units/day)? Don’t they
make glycaemic control worse?

Question 28
What is the importance of potassium chloride (KCl) in the treatment of a
diabetic patient (pre-operative care)? The formula in the text is explained
as 16 U of insulin _ 10 mmol of KCl _ 500 mL 10% glucose.

Question 29
What is the cut-off point of daily albumin excretion above which a
diabetic patient without hypertension should be given an angiotensinconverting
enzyme (ACE) inhibitor?

Question 30
What is the urinary concentration or 24-hour urine albumin content above
which angiotensin-converting enzyme (ACE) inhibitors should be started
in diabetic patients? Does an albumin (in microgram)/creatinine (in
milligrams) ratio above 30 in the morning sample indicate a need for this?
Diabeti dhe komplikimet Erëblin Lahu

Question 31
Do potassium channel activators such as nicorandil have any benefit in
the treatment of a diabetic patient with cardiovascular complications?

Question 32
Is a dosage of 2.5 mg/day of methyltestosterone, as a component in
some multivitamin formulae, safe to give to diabetics or will it make the
diabetes more difficult to control (see also Chapter 5, question 5)?

Question 33
How does diabetes mellitus cause atherosclerosis?

Question 34
How does diabetes cause renal damage, especially diabetic nephropathy
with the presence of microalbuminuria?

Question 35
Type 1 diabetes causes nephropathy in 40% of cases and type 2 causes it
in 20% of cases but the most common cause of nephropathy we see is
type 2, why?

Question 36
Why is intractable vomiting seen in diabetes mellitus and how can it be
managed?
202
Question 37
Is gabapentin superior to carbamazepine in terms of efficacy in the
treatment of painful diabetic neuropathy? What are its side-effects?

Question 38
Why is diabetic ketoacidosis more common in type 1 diabetes?

Question 39
Why is there abdominal pain in diabetic ketoacidosis?

Question 40
Grades of ketonuria are sometimes mentioned. I have not been able to
locate a detailed description in textbooks and would be grateful if you
could explain the grades of ketonuria or recommend suitable reading
material.

Question 41
What false-positive factors could cause ketone bodies to appear in the
urine in a non-diabetic patient?

Question 42
Why is tetanus not seen in a diabetic foot wound?
Diabeti dhe komplikimet Erëblin Lahu

Question 43
Can impaired glucose tolerance cause recurrent lower motor facial palsy?

Question 44
Can long-term diabetes mellitus cause vertigo not accompanied by other
brainstem signs?

Question 45
We know that type 2 diabetes mellitus provokes left ventricular diastolic
dysfunction. Does chronic stable angina, associated with type 2 diabetes
mellitus, further increase the prevalence of left ventricular diastolic
dysfunction?

Question 46
Is there adequate evidence for choosing an angiotensin-converting
enzyme (ACE) inhibitor or antagonist for the initial management of
raised blood pressure in type 2 diabetes, or is it now advisable to choose
any tolerated antihypertensive?

Question 47
Why is there immunosuppression in diabetes?
203
Question 48
Dextrose infusion in quinine induced hypoglycaemia causes more
hypoglycaemia, so what is to be used?

Question 49
Does the serum cholesterol level rise with age?

Question 50
Please explain the significance of having normal total high-density
lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol but a
raised lipoprotein (a) [Lp(a)] in a normotensive, non-smoking patient?

Question 51
In the diet of hypercholesterolaemic patients, should milk and other
dairy products be restricted?

Question 52
Should a 20-year-old, either male or female, with a blood cholesterol
level of 300mg/dL and with hypercholesterolaemic parents, be treated?

Question 53
Why are lipid-lowering drugs (statins) administered at bed time?

Question 54
What is the best statin now and what is your opinion about Crestor 10 mg
(rosuvastatin) and Lescol XL (fluvastatin sodium)?
Diabeti dhe komplikimet Erëblin Lahu

Question 55
How long do statins take to achieve their maximum benefit?

Question 56
If, after 4 months of taking simvastatin (20 mg daily), a patient with
hyperlipidaemia and hypertension has an increased aspartate transferase
(AST) of up to 60 U/L, with a normal alanine transferase (ALT), what
action should I take?

Question 57
How long should the statins be continued once the lipid profile returns to
normal? Can we stop the statins once normal levels are attained and then
continue with diet modification?

Question 58
What is the exact mechanism of corneal arcus? What is its clinical
significance? What is its relationship to hyperlipidaemia? Is there any
effective treatment in medicine or alternative medicine to remove
corneal arcus?

Question 59
What is the best drug to be added to a statin in a case of familial
hypercholesterolaemia not responding to lifestyle and diet modification
plus a statin?

Question 60
Can diabetes mellitus cause Horner’s syndrome? If so, how?

Question 61
Is it typical for a diabetic patient to experience angina during myocardial
ischaemia?

Question 62
What are the causes of a flat oral glucose tolerance test (GTT)?

Question 63
Are there any indications for routinely prescribing a statin (simvastatin, for
example) in hypertensive and/or diabetic patients as prophylactic therapy?

Question 64
What are the causes of vomiting and other gastrointestinal tract problems
in type 2 diabetes mellitus? What is the correct treatment for a patient
with nausea and vomiting, already taking hypoglycaemic agents and
antihypertensives?

Question 65
In diabetic ketoacidosis there is an overall potassium deficit. Since insulin
promotes cellular potassium uptake, potassium should be given along
with insulin in the treatment of ketoacidosis since hypokalaemia could
Diabeti dhe komplikimet Erëblin Lahu

potentially cause tachycardia. Why? I realise that hyperkalaemia can cause

problems since the concentration gradient and therefore the membrane
potential is reduced thus inhibiting proper function, but what is the
problem with hypokalaemia? Is it that the membrane potential and the
concentration gradient are too large? If so, how is this possible considering
that the body may have too little potassium to make the intracellular
concentration approach normal, so that although the extracellular
concentration is reduced, the intracellular concentration is also reduced?

Question 66
Can diabetes mellitus result in Horner’s syndrome with no other
neurological deficit?

Question 67
Which drug is best recommended for a diabetic patient with rheumatoid
arthritis resistant to methotrexate, and requiring frequent pushes with
intramuscular depot preparations of methylprednisolone?